Understanding Stigma: Results of a Mixed Methods Evaluation of An Anti-Stigma Program for Healthcare Providers in Canada

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1 Understanding Stigma: Results of a Mixed Methods Evaluation of An Anti-Stigma Program for Healthcare Providers in Canada #OpeningMinds Stephanie Knaak, PhD Opening Minds, MHCC Together Against Stigma, Copenhagen, Denmark, September 20-22, 2017

Mental Health Commission of Canada 2006: Senate Committee publishes Out of the Shadows at Last first and largest national study on mental health, mental illness and addictions 2007: The MHCC is

2 Mental Health Commission of Canada 2006: Senate Committee publishes Out of the Shadows at Last first and largest national study on mental health, mental illness and addictions 2007: The MHCC is created by the Government of Canada Key Areas: Housing and Homelessness, Stigma, Workplace, Mental Health Strategy for Canada, Recovery, Peer Support, Suicide Prevention 2009: Launch of Opening Minds: anti-stigma initiative 2017: Renewed mandate

3 Opening Minds Mental illness anti-stigma initiative of the Mental Health Commission of Canada Why reinvent the wheel? Identify successful anti-stigma programs through scientific evaluation Use existing evidence as a guide: contact-based education Promote successful programs and best practices across Canada Four target groups: health care providers, youth, the news media, and the workplace + 25 hcp programs evaluated

4 Program Evaluation Quantitative Pre-post-follow up design; OMS-HC 6 program replications; pooled analysis Qualitative What elements of program impacted most Recommendations for improvement Behaviour change

5 Program Details Setting, Target audience and Program Details of Understanding Stigma Implementations Study Number Province Healthcare setting Audience Program version Booster session? 1 BC Hospital ED staff Original No 2 Nova Scotia Hospital Clinical and non-clinical staff Original No 3 BC Hospital Clinical and non-clinical staff Condensed No 4 Ontario Hospital ED staff Condensed Yes 5 Ontario Hospital ED and mental health staff Original Yes 6 Ontario Community Health Centre Clinical and non-clinical staff Original Yes

6 Understanding Stigma Program Details: 2 hr and 1 hr versions available; booster modules also available Social contact (in-person testimony + video) and educational (stigma + myth busting) and reflective/action components Workshop Goals: Increase awareness and knowledge about the impact of stigma Develop understanding that healthcare providers can make a difference Improve attitudes and behaviours (esp. patient-provider interactions)

7 What s Your Gut Feeling? 1. What are some of the issues related to stigma in this scenario? 2. Could this create a barrier to getting or continuing with treatment? How? You overhear two of your colleagues talking with one another. Oh God, she s tried to kill herself again. She always seems to take just enough to get sick, but not enough to really do the job. I really don t have time for this, especially when there are lots of really sick people who want to get better.

8 Understanding Stigma -- Video

9 Participant Characteristics n % Study Number 1** % % % % % % Program version: Original % Booster session: Yes % Occupation Nurse % Physician % Allied health % Other (non-clinical) % Gender: Female % Age (M = 40.5) % Ever been treated for a mental illness?: Yes % **No follow up measure

10 Quantitative Analysis Mixed model analysis Significant improvement for total scale and subscales (p <.001) No difference for hcp type; program version; gender; previous diagnosis of a MI Inverse association between increasing age and score improvement Outcomes maintained for participants who attended booster Meta regression for program outcomes by site Overall combined effect size =.30 (Cohen s d) Program effects ranged from.19 to.51 Publication:

11 What Element Impacted Most 100% 90% 80% 70% 70,8% % of cases 60% 50% 40% 30% 20% 10% 0% Personal testimony 18,3% 11,8% 10,8% Video Myths & Facts Group discussions 6,9% 6,6% Earache/stigma exercise Other 2,4% All

12 Suggestions for Improvement 70% 60% 50% 40% 30% 44,3% 48,3% 20% 10% 0% 7,4% No change / expand program More / longer Other % of respondents (n=379)

13 More / longer Add a section dedicated to strategies to use in the workplace Could be longer. More personal stories Have another exercise that specifically looks at how to apply the knowledge/tools really looking at how change can be made. Great program maybe 30 minutes longer with another guest speaker. The personal stories really assisted my understanding of mental illness

14 How will Behaviour Change? No response Other Will call others out / stop gossip Refresher of what already knew / general More advocacy More confidence to approach / less fear More self aware (of behaviours/reactions/attitudes) More aware of stigma on pwle More understanding/compassion/patience/empathy Improve communication (better listening, etc) Less judgmental Language /labelling 0,8% 10,5% 4,7% 12,6% 5,9% 5,9% 11,7% 5,1% 9,1% 7,3% 7,7% 18,8% 0% 5% 10% 15% 20% % of responses

15 What we ve Learned Program strengths: Effective at reducing stigma Good fit for nearly all healthcare provider groups Adaptable; helps with ease of implementation Program well-received Considerations: Physicians less likely to participate Implement with boosters / not as a one-off

16 Next Steps Program Resources Available for Sharing Taking Understanding Stigma online launching in November Multiple personal stories + scenario-based exercises Adding section on trauma informed care Adding more about recovery Myths and Facts: updating Understanding Stigma evaluation publication Knaak S, Szeto A, Kassam A, Hamer A, Modgill G, Patten S. (2017) Understanding Stigma: A Pooled Analysis of a National Program Aimed at Healthcare Providers to Reduce Stigma towards Patients with a Mental Illness. JMHAN, 1(1):e19- e29.

17 Questions? Comments?

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Evaluation of IWK s Understanding the Impact of Stigma Program

Evaluation of IWK s Understanding the Impact of Stigma Program Brianna Kopp, Stephanie Knaak and Scott Patten December 2013 www.mentalhealthcommission.ca This project was made possible through funding